SMLE Internal Medicine

Question 1

A 55-year-old male presents with polyuria, polydipsia, and a fasting blood glucose of 9.5 mmol/L on two occasions. What is the most appropriate initial management?

Accepted Answer

Lifestyle modification and metformin

Answer

Insulin glargine

Answer

Sulfonylurea monotherapy

Answer

GLP-1 receptor agonist

Question 2

A 60-year-old patient with a history of atrial fibrillation presents with sudden onset right-sided weakness and aphasia. CT brain shows no haemorrhage. What is the most appropriate immediate intervention?

Accepted Answer

IV alteplase within the thrombolytic window

Answer

Aspirin 300 mg immediately

Answer

Heparin infusion

Answer

Observation and repeat CT in 24 hours

Question 3

Which autoantibody is most specific for systemic lupus erythematosus (SLE)?

Accepted Answer

Anti-double-stranded DNA (anti-dsDNA)

Answer

Anti-nuclear antibody (ANA)

Answer

Anti-Ro (SSA)

Answer

Rheumatoid factor

Question 4

A 45-year-old woman presents with progressive dyspnoea and a butterfly-shaped infiltrate on chest X-ray. She has a history of mitral stenosis. What is the most likely cause of the radiographic finding?

Accepted Answer

Pulmonary oedema

Answer

Community-acquired pneumonia

Answer

Pulmonary embolism

Answer

Sarcoidosis

Question 5

A patient with chronic kidney disease stage 4 has a serum potassium of 6.2 mmol/L and peaked T waves on ECG. What is the most urgent first step?

Accepted Answer

IV calcium gluconate

Answer

Oral sodium polystyrene sulfonate

Answer

IV insulin with dextrose

Answer

Urgent haemodialysis

Question 6

A 30-year-old male from Riyadh presents with fever, dry cough, and bilateral ground-glass opacities. He works at a camel farm. What is the most likely causative organism?

Accepted Answer

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Answer

Mycobacterium tuberculosis

Answer

Influenza A H1N1

Answer

Coxiella burnetii